Ambulatory Patient Safety Toolkit 2019

Ambulatory Patient Safety

Toolkit 2023

A resource for clinicians and staff provided by HealthPartners Ambulatory Safety Program

HealthPartners is committed to eliminating harm due to error in the delivery of medical care. The HealthPartners Ambulatory Safety Toolkit provides practical tools and suggestions that you may wish to incorporate into clinical operations or adapt to create your own initiatives. We include links to national and local safety resources and protocols, organized by topic. A complete listing of HealthPartners administrative policies can be found on the Provider Portal at .

To date, relatively little research has focused on patient safety in the ambulatory setting. Yet most care is delivered in these settings. Although the ambulatory setting might seem less intense (and less "dangerous") than an inpatient setting, lapses in safety can and do occur, with adverse consequences.

A "culture of patient safety" is an essential ingredient of the safe health care organization. "Culture" can be understood as habits, attitudes, and beliefs that live in the minds of the people who work in the organization and guide the work that they do. Concepts closely related to "culture" are "environment" and "mindset."

The knowledge, skill and judgment of the clinician are essential, of course. In the modern group practice, clinic, and outpatient center, the clinician operates through organizational systems and processes, which together produce the desired clinical outcome.

Research has shown that serious errors occur more often from a failure of process and systems, rather than the action of a single individual. Well-designed systems and processes allow the organization to deliver care with reliability, consistency, and resiliency (the ability to detect and quickly recover from an error before harm occurs).

Our goal with this toolkit is to promote these sorts of systems and processes. Together, we can improve the safety of care delivered in the ambulatory setting. We welcome comments and feedback. We are committed to continually improving this toolkit. Please feel free to contact us by email at quality@.

Sara Spilseth, MD, MBA Associate Medical Director for Quality HealthPartners Health Plan

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Table of Contents

Clinic Assessment of Safety Culture ...........................................................................................................4 Infection Control/Hand Hygiene...................................................................................................................5 Safety Learning Reports ..............................................................................................................................6 Health Literacy ..............................................................................................................................................7 Patient Engagement (motivational interviewing) ........................................................................................8 Medication Safety: Sampling .......................................................................................................................9 Medication Safety: Do Not Use Abbreviations..........................................................................................10 Medication Safety: Medication Reconciliation ..........................................................................................11 Medication Safety: Protocols for Use of Hazardous Drugs and Controlled Substances.......................12 Medication Safety: Antibiotic Prescribing..................................................................................................14 Medication Safety: Prescription Refills......................................................................................................15 Medication Safety: Generic Prescribing ....................................................................................................16 Reporting Results: Follow up from Tests and Procedures ......................................................................17 Appendix .....................................................................................................................................................18

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Clinic Assessment of Safety Culture

Identify the Safety Risk

Evaluation of a culture of safety refers to measurement components such as management behaviors, safety systems, and employee perceptions of safety. A variety of survey tools is available to identify potential gaps and improvement initiatives concerning patient safety. While many surveys address the safety climate, we endorse the U.S Preventative Services Task Force (USPSTF).

Suggestions for Improvement

? Clinics should track errors that occur within the standard practice of medicine.

? All staff members should use a standard error report. All staff must be comfortable with reporting errors. ? Review Tools for Incident Reporting. Establish a "Safety Learning Report" format.

? Consider providing a thank you note or "kudos" when someone submits an error report or "good catch." ? Complete culture surveys to assist in identifying progress in this area. A safety officer, committee, or

leader could review the reports and monitor trends to prioritize improvement projects. If a clinic is large enough, the detail could be entered into a database to track and assist in analysis.

Sample Forms & Article

AHRQ Patient Safety Culture (SOPS) Hospital Survey

Other Resources ?Links

Agency for Healthcare Research and Quality

AHRQ Patient Safety Tools and Resources

References

AHRQ Healthcare-Associated Infections Program

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Infection Control/Hand Hygiene

Identify the Safety Risk

Since December 2019, the coronavirus (COVID-19) global pandemic continues to impact people, businesses, and institutions across national and international health care systems. These systems created different protocols and procedures to navigate and mitigate the spread of COVID-19.

Infection prevention and control are essential in achieving the triple aim of health, such as patient experience, affordability for our patients, and providing a safe work environment for our employees. Infection control promotes safe practices related to the prevention and spread of disease and provides best practice information and consultation regarding infectious disease management.

Hand washing is the single most important means of preventing the spread of infections, germs, and viruses.

Suggestions for Improvement

? Set standards and guidelines for hand hygiene and infection control in clinics

? During a pandemic, additional infection control measures should be put into action to minimize the spread of the virus

? Develop a pandemic response plan or team to ensure the health and safety of the organization's employees and patients in clinics

Sample Forms & Article Infection Prevention and Control Hand Hygiene World Health Organization HealthPartners Covid-19 Resources

Other Resources ?Links Infection Prevention and You Centers for Disease Control and Prevention

Minnesota Department of Health

References CDC Coronavirus (Covid-19)

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Safety Learning Reports

Identify the Safety Risk

Sometimes system errors such as "near misses" occur in the clinic unnoticed. If these errors continue, they can lead to patterns of concern. However, once mistakes are reported, it is unknown where the errors originated from. The standard practice of medicine leans towards Safety Learning Reports to track the trend of errors, "good catches" when they occur.

Incident reports lead to negative connotations that change the tone of the statement. Identifying these errors as safety learning or quality improvement (QI) reports may minimize incident reports, promote open dialogue, and review an event from a systems perspective. Even near-misses could be tracked and collected.

Safety learning, or QI reports, can help identify things that may be wrong with the system that leads to errors or provide details on what was right with the design that helped prevent a mistake.

Suggestions for Improvement

? Establish and utilize a survey tool to assess safety risk within the clinic's safety culture ? Use the safety culture results to determine the team's comfort level in reporting incidents and in

reviewing learning reports, near misses, and good catches ? If survey results indicate improvement, develop an education toolkit and schedule teambuilding around

reporting incidents, near misses, good catches, and safety learning ? If you do not have a current safety learning report format (or report for incidents), obtain samples, and

form a committee to review and select one, or use one and implement updates specific to the clinic ? Establish a protocol for safety learning reports. Make sure that the protocol addresses learning

definitions such as near misses and good catches ? Have a safety champion review and compile data on the safety learning events identified through

reports each quarter. Enter details into a database and monitor for trends ? Use this analysis to identify and prioritize areas for improvement ? Develop action plans around the outcomes seen ? Continue ongoing monitoring of safety culture and quality improvement

Other Resources ? Links Patient Safety Network MN Alliance for Patient Safety AHRQ Quality Reports Institute for Healthcare Improvement (IHI)

References AHRQ Reports and Resources

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Health Literacy

Identify the Safety Risk

Effective communication is the heart of health care relationships. At least 50 percent of the US population cannot understand and use the information provided by their clinicians.

Health Literacy is an individual's ability to read and comprehend prescription bottle labels, appointment slips, and other essential health-related materials required to function as a patient successfully.

Research shows health literacy is a stronger predictor of health status than age, income, employment status, education level, or racial and ethnic group. Health literacy barriers lead to misunderstood health care instructions, prescriptions, and appointment slips (no-shows), poor health outcomes, and medical errors.

HealthPartners recommends taking a universal precautions approach. This means to approach all patients the same. All patient education materials, forms, and letters are at a 7th-grade reading level. All explanations use non-medical language. Health Literacy affects a person's ability to engage in self-care chronic disease management. See the "Patient Engagement Section" of this toolkit for additional ideas.

Suggestions for Improvement

? Use non-medical terminology, focus on one to three key messages, show, or draw a simple picture when giving instructions or educating the patient about their medical condition.

? Ask patients to recall and restate instructions about their medication, what they are to do when they get home, etc.

? Provide detail on cultural appropriateness. Several resources have educational materials available in multiple languages.

? Create a calendar to continue to covert materials by topic in your clinic over time. Create a shame-free environment and use patient-friendly and culturally appropriate materials.

Sample Forms & Article HealthPartners Literacy Guidelines AHRQ Patient Assessment Tools Round table on Health Literacy Teach-back Method

References CDC Health Literacy

AHRQ Health Literacy

NPIN Health Communication Language and Literacy

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Patient Engagement (motivational interviewing)

Identify the Safety Risk

A critical component of ongoing medical care is having the patient engaged and empowered in their care. Patient's interest levels in their care can change over time: motivational interviewing combines personcentered care and patient engagement. Steps can be put in place to promote your patient/patient family health engagement by removing literacy barriers. Informed patients are more engaged and actively involved in their therapy. Patient partnering will include providing patients with tools to help them become more knowledgeable. What efforts has your clinic made to involve patients in their safety?

Suggestions for Improvement

? When providing patients with written materials, be sure that they are at the 7th-grade reading level and are in plain language. When explaining medical conditions or educating patients, use the "Teach-Back Method." See the Health Literacy section of this toolkit for additional ideas.

? Use a tool to assess the underlying knowledge, skills, and confidence of a patient's health and healthcare needs, such as the Patient Activation Measure (PAM).

? Provide all patients with an understanding of the roles and responsibilities of their care delivery team ? Engaged patients may want additional help when faced with multiple options for the care of specific

conditions/diseases. Shared decision-making tools address this need. ? Provide each patient with copies of their medication lists. "Apps" will show a picture of the medication

for people with low health literacy. ? Engage patient family members or, if appropriate, assist the patient in engaging home health resources

for medication distribution. ? Make it a routine part of your care process to create an after-visit summary regarding the patient's self-

care and medication safety. ? Include Motivational Interviewing in the script or when doing a patient assessment

Other Resources ? Links Insignia Health Motivational Interviewing

References AHRQ Patient Engagement and Education

AHRQ Motivational Interviewing Strategies to Engage Patients

IHI What is Motivational Interviewing?

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